How Do You Want to Live? Shifting the Narrative Around End of Life Care


Many physicians face a conundrum. While their extensive years of training emphasize providing care, treatments, and intervention in order to maintain life, the truth is, death is inevitable and a reality we all must face. According to Dr. Timothy Ihrig, a palliative care specialist and chief medical officer at Crossroads Hospice, because the medical field is constructed around the idea of intervening at all costs, patients and families are often put into a position of prolonging death versus preserving life.

It’s Not About Dying

Ihrig completed his palliative medicine and hospice training at Stanford University and is a nationally recognized expert in both fields. Committed to patient-centered care, he believes palliative care has the potential to transcend and transform the healthcare system. He is a longstanding advocate for treating patients with life-limiting illnesses according to their individual priorities and life goals. Ihrig encourages a reframing of the conversation around the ways in which we think about and discuss death and end of life. For him, it’s not about dying, but about living.

That shift, Ihrig believes, is instrumental to reforming how we provide care, and extremely empowering for patients. When we focus on life and ask patients how they want to live, rather than focusing on death as the outcome, we define what we hope for and what we’re fighting for. Ihrig believes that it’s never too early to have these conversations in order to articulate what is meaningful to us. While a medical diagnosis or advanced age will often prompt these conversations, Ihrig believes we should all ask the people we love the following questions:

  • What is sacred to you?
  • What is in your heart?
  • How do you want to live?

For everyone, there comes a point in life where our body can no longer recover. This inflection point – where interventions, therapies, and treatments become a negative for the patient — is important for both the patient and the physician. Accepting and acknowledging that the journey of life has a beginning and an end is a way to reframe the narrative.

The Truth About Life

Ihrig encourages people to hold physicians responsible for telling the truth. If a physician doesn’t tell the patient the truth about a diagnosis or the likely outcome, then the patient loses the opportunity to write his or her own chapter – whether that is a few pages, or ten chapters. Failure to tell the truth can cause pain and suffering. The goal for any physician and patient should be to move forward collaboratively so that the patient can live the life he or she wants.

Having conversations about how you want to live enables those who love you to advocate appropriately on your behalf. Ihrig cites an example of an 87-year-old dementia patient who falls and breaks her hip. What should be done for this person? Just because we can, doesn’t mean we should. While an orthopedist will insist the hip should be repaired, are there other options? If the individual isn’t in pain, can surgery be refused? Ihrig encourages individuals and families to peel back the onion in order to get to the bottom of what is best for their loved one. According to Ihrig, we need to empower providers to be comfortable with the truth.

Palliative Care

For doctors who specialize in palliative care, there is a particular struggle between how the quest for clinical truth intersects with what a patient is experiencing. From a clinical perspective, doctors are trained to alleviate suffering. But equally important, Ihrig believes, is lifting up and empowering patients. It is important to discover what is sacred to that individual — whether that is overcoming pain, fear of the unknown, or something else. Rather than a physician asking, ‘Do you want to die?’ we should move beyond that and ask a patient ‘How do you want to live?’

Shifting the narrative in this way is liberating for patients, families and healthcare providers because by asking, ‘How do you want to live?’ you align yourself with life rather than with death, which is impossible to overcome. By making these conversations a priority and expressing what is in their hearts, people move beyond being afraid, allowing them to live, learn, love and grow.

The Help Choose Home Podcast

Listen to the full interview with Dr. Timothy Ihrig in the Help Choose Home podcast series to learn more. This episode and others in the series can be found on Apple Podcasts or Google.

The Help Choose Home podcast series provides information and resources for families about senior home health options. Podcasts are hosted by Merrily Orsini, executive vice president of Axxess and president and CEO of corecubed, an award-winning home care marketing solutions agency.

Help Choose Home is a collaborative effort by the National Association for Home Care and Hospice (NAHC), Axxess, and corecubed to educate the public about the many benefits of the in-home care industry, which includes non-medical home care, private duty nursing care, medical home health, hospice, and other in-home health and wellness services.

If this episode has been helpful, be sure to leave a five-star review and share the podcast with your friends to help us in the national effort to help choose home! You can connect with Merrily Orsini on Twitter @MerrilyO.

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